This study seeks to determine, using special sleep tests (polysomnography and actigraphy) if guanfacine extended release is able to improve nighttime sleep in children with ADHD - associated insomnia while improving daytime ADHD symptoms. Male and female children with diagnosed or suspected ADHD with sleep problems (difficulty falling asleep, difficulty staying asleep, or less than expected hours of sleep) will be recruited. After obtaining informed consent and assent (when appropriate) and after discontinuation of excluded medications, children will have evaluations of his or her sleep and evaluations confirming the ADHD diagnosis. Children who successfully pass screening will be enrolled into the double-blind, placebo-controlled, randomized investigation with 50% of participants receiving guanfacine extended release and 50% of participants receiving matching placebo. Using a flexible-dose optimization design based on ADHD symptom improvement and medication tolerability, the dose will be adjusted between 1 to 4 mg over the course of four weeks. At the end of medication adjustment (week 4 or 5), ADHD questionnaires, sleep questionnaires, and sleep tests will be repeated and analyzed. The medication will be weaned over the course of the following 3-10 days.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
29
Guanfacine extended-release tablets will be started at 1mg and then increased at weekly intervals to 2mg, 3mg, or 4mg as needed and as tolerated
Placebo tablets identical to the experimental arm guanfacine extended-release tablets 1mg, 2mg, 3mg, 4mg, but without the active ingredient (guanfacine).
Children's Specialized Hospital
Hamilton, New Jersey, United States
Children's Specialized Hospital
Toms River, New Jersey, United States
Change in Polysomnographic Total Sleep Time (TST)
Change in objective measures of sleep, using polysomnography
Time frame: Baseline to last observation carried forward (after at least one week of dose stability)
Change in Baseline to Treatment ADHD-Rating Scale IV Total Score
Change in baseline to treatment ADHD-Rating Scale IV (Investigator-interview ) total. This scale quantitates ADHD symptoms based on DSM-IV criteria with a minimum score of 0 and a maximum score of 54 (higher scores suggesting more ADHD symptoms). The total score is a sum of the 9 items on the ADHD Rating Scale IV inattention score and the 9 items on the ADHD Rating Scale IV hyperactivity-impulsivity score (scores for each 0-27).
Time frame: Baseline to last observation carried forward (after at least one week of dose stability)
Change in Baseline to Treatment Latency to Persistent Sleep (LPS)
Change in an objective measure of sleep onset, using polysomnography.
Time frame: Baseline to last observation carried forward (after at least one week of dose stability)
Change in Baseline to Treatment Minutes of Wake Time After Sleep Onset (WASO)
Polysomnographic parameter of sleep assessing how many minutes of wakefulness occurred after sleep onset and before full morning awakening.
Time frame: Baseline to last observation carried forward (after at least one week of dose stability)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.